Advance Health Care Directives and End of Life Choices


The tragic case of the Oakland twelve-year old girl, declared brain dead after a routine surgery by the hospital, and her parent’s plea to keep her connected to a ventilator nonetheless, reminds me yet again of the value and importance of completing an Advance Health Care Directive.  

This document allows you to name agents to act on your behalf with respect to health care decisions and to state your wishes for end of life care. 

In the immediate case, of course, the girl was a minor, and would not have been able to make her own advance health care directive, so it is her parents who are making those choices for her. For the rest of us, this case is a cautionary tale–it is important to let people know what your choices would be at the end of life if you are not going to be able to communicate your wishes yourself, otherwise you won’t have any control over how that decision gets made.

The Supreme Court first recognized a constitutional right to die in 1990 in the Cruzan case, in which the parents of Nancy Cruzan fought the state of Missouri all the way to the Supreme Court for the right to disconnect their daughter from artificial food and hydration after she had spent many years in a persistent vegetative state. The case, in the end, turned on what Nancy “would have wanted” if facing this fate.

Don’t leave your family with any uncertainty about whether you would like them to disconnect you from life support (usually either artificial respiration, as in the Oakland case, or artificial nutrition, as in the Cruzan case) and medicate you only for comfort, or whether you’d like such artificial means of life support to be continued within the limits of generally accepted health care standards. You can also write out your wishes for hospice care and any other end of life issues that concern you.

In California, an Advance Health Care Directive is the legal document that allows you to both name agents to act on your behalf with respect to health care decisions and state your wishes for end of life care. This Directive is part of every estate plan that we do for our clients, and you can purchase the same form we use directly from the California Medical Association. Most large health care providers, like Kaiser, and many large hospitals, offer their own forms as well. 

Whatever forms you use, please make sure to also have a discussion with your family about your wishes for end of life care — I often tell my clients that the discussion is as, or more, important than the document itself. When faced with such a difficult decision, it gives great comfort to family members to know that your wishes are being respected and that, whatever choice you’ve made, they can honor and respect it on your behalf.